Electroporation ablation apparatus, system, and method

ABSTRACT

A surgical instrument, such as an endoscopic or laparoscopic instrument, includes an ablation device. The ablation device includes an elongate relatively flexible member having a proximal end and a distal end, the flexible member includes at least a first working channel. A first and second electrode extends from a working channel at the distal end of the flexible member. The first and second electrodes are adapted to be endoscopically located in a tissue treatment region. The first and second electrodes are adapted to couple to an electrical waveform generator to receive an irreversible electroporation electrical waveform sufficient to ablate tissue located between the first and second electrodes. The waveform parameters of the irreversible electroporation electrical waveform are determined based on image information received from the tissue treatment region.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 12/694,452, filed Jan. 27, 2010, entitledELECTROPORATION ABLATION APPARATUS, SYSTEM AND METHOD, now U.S. PatentApplication Publication No. 2010/0130975, which issued as U.S. Pat. No.8,449,538 on May 28, 2013, which is a divisional application, under 35U.S.C. §121, of U.S. patent application Ser. No. 11/706,766, filed Feb.15, 2007, entitled ELECTROPORATION ABLATION APPARATUS, SYSTEM, ANDMETHOD, now U.S. Pat. No. 7,655,004, which is related to U.S. patentapplication Ser. No. 12/635,298, filed Dec. 10, 2009, entitledELECTROPORATION ABLATION APPARATUS, SYSTEM, AND METHOD, now U.S. Pat.No. 8,029,504, and U.S. patent application Ser. No. 11/706,591, filedFeb. 15, 2007, entitled ELECTRICAL ABLATION APPARATUS, SYSTEM, ANDMETHOD, now U.S. Patent Application Publication No. 2008/0200911, eachof which is incorporated herein by reference in its entirety.

BACKGROUND

Electrical therapy techniques have been employed in medicine to treatpain and other and other conditions. Electrical ablation techniques havebeen employed in medicine for the removal of diseased tissue or abnormalgrowths from the body. Nevertheless, there is a need for improvedmedical instruments to electrically ablate or destroy diseased tissue orabnormal growths from the body, such as cancer tissue. There may be aneed for such electrical therapy techniques to be performedendoscopically.

Electrical therapy probes comprising electrodes may be required toelectrically treat diseased tissue. The electrodes may be introducedinto the patient endoscopically to the tissue treatment region bypassing the electrodes through the working channel of an endoscope.

SUMMARY

In one another general aspect, the various embodiments are directed toan apparatus. In at least one embodiment, the apparatus comprises afirst channel and a second channel; a first probe positioned at leastpartially within the first channel, wherein the first probe comprises afirst distal portion and defines a first longitudinal axis; and a firstrotatable electrode coupled to the first distal portion of the firstprobe and laterally offset from the first longitudinal axis, wherein thefirst rotatable electrode is structured to rotate about the firstlongitudinal axis. The apparatus further comprises a second probepositioned at least partially within the second channel, wherein thesecond probe comprises a second distal portion and defines a secondlongitudinal axis; and a second rotatable electrode coupled to thesecond distal portion of the second probe and laterally offset from thesecond longitudinal axis, wherein the second rotatable electrode isstructured to rotate about the second longitudinal axis, and wherein thefirst and second rotatable electrodes are configured to couple to anelectrical waveform generator and to receive an irreversibleelectroporation electrical waveform. The apparatus further comprises anadjustable ablation region defined between the first and secondrotatable electrodes, wherein the ablation region is adjustable byrotating at least one of the first and second electrodes.

In yet another general aspect, the various embodiments are directed to asystem. In at least one embodiment, the system comprises a first channeland a second channel; a first probe positioned at least partially withinthe first channel, wherein the first probe comprises a first distalportion and defines a first longitudinal axis; and a first rotatableelectrode extending from the first distal portion of the first probe andlaterally offset from the first longitudinal axis, wherein the firstrotatable electrode is structured to rotate about the first longitudinalaxis. The system further comprises a second probe positioned at leastpartially within the second channel, wherein the second probe comprisesa second distal portion and defines a second longitudinal axis; and asecond rotatable electrode extending from the second distal portion ofthe second probe and laterally offset from the second longitudinal axis,wherein the second rotatable electrode is structured to rotate about thesecond longitudinal axis, and wherein the first and second rotatableelectrodes are coupled to an electrical waveform generator andstructured to receive an irreversible electroporation electricalwaveform. The system further comprises an adjustable ablation regiondefined between the first and second rotatable electrodes, wherein theablation region is adjustable by rotating at least one of the first andsecond electrodes.

In another general aspect, the various embodiments are directed to amethod. In at least one embodiment, the method comprises positioning anelongate member comprising first and second channels within a bodycavity, wherein a first and a second probe are disposed within therespective first and second channels, wherein the first and secondprobes each define a central axis, wherein a first and second electrodeare coupled to the distal ends of the respective first and secondprobes, and wherein the first and second electrode are laterally offsetfrom the central axes of the respective first and second probes. Themethod further comprises rotating at least one of the first and secondprobes about the central axis of the respective at least one first andsecond probes to adjust an ablation region positioned between the firstand second electrodes.

FIGURES

The novel features of the various embodiments of the invention are setforth with particularity in the appended claims. The various embodimentsof the invention, however, both as to organization and methods ofoperation, together with further objects and advantages thereof, maybest be understood by reference to the following description, taken inconjunction with the accompanying drawings as follows.

FIG. 1 illustrates one embodiment of an endoscopic ablation system.

FIG. 2 is an enlarged view of one embodiment of a therapeutic/diagnosticprobe of one embodiment of the endoscopic ablation system shown in FIG.1.

FIG. 3A is a side view of a distal end of one embodiment of atherapeutic/diagnostic probe comprising a biopsy probe and an electricaltherapy electrode assembly.

FIG. 3B is a sectional view of one embodiment of atherapeutic/diagnostic probe taken along section line 3B-3B showing thegeometric relationship between the electrodes and the diagnostic probes.

FIG. 4 is a sectional view of the lower end of an esophagus and theupper portion of a stomach of a human being.

FIG. 5 illustrates the use of one embodiment of an endoscopic ablationsystem to treat diseased tissue in the lower esophagus.

FIG. 6 illustrates the use of one embodiment of an endoscopic ablationsystem to treat diseased tissue in the lower esophagus.

FIG. 7 illustrates one embodiment of a necrotic zone defined by thegeometry and placement of the electrical therapy electrodes.

FIG. 8 is a sectional view taken along the longitudinal axis of oneembodiment of an endoscopic ablation system shown in FIG. 1.

FIG. 9 is an end view taken along line 9-9 of one embodiment of atherapeutic/diagnostic probe of the endoscopic ablation system shown inFIG. 8.

FIG. 10 is a sectional view taken along line 10-10 of a rotation tube ofthe endoscopic ablation system shown in FIG. 8.

FIG. 11 shows one embodiment of a distal portion of an endoscopicablation system shown in FIG. 1 partially inserted into the esophagus ofa patient.

FIG. 12 is a diagram of one embodiment of a control loop for oneembodiment of an irreversible electroporation therapy procedure to treatdiseased tissue as described herein.

FIG. 13 illustrates one embodiment of an electrical scalpel fordissecting tissue.

FIG. 14 is a graphical representation (graph) of electric field strength(along the y-axis) as a function of distance from an electrical therapyelectrode under various conductivity environments near diseased tissue.

FIG. 15 is a close up of the graph shown in FIG. 14.

DESCRIPTION

The various embodiments described herein are directed to diagnostic andelectrical therapy ablation devices. The diagnostic devices comprisebiopsy probes. The electrical therapy ablation devices comprise probesand electrodes that can be positioned in a tissue treatment region of apatient endoscopically. An endoscopic electrode is inserted through aworking channel of an endoscope. The placement and location of theelectrodes can be important for effective and efficient therapy. Oncepositioned, the electrical therapy electrodes deliver electrical currentto the treatment region. The electrical current is generated by acontrol unit or generator external to the patient and typically hasparticular waveform characteristics, such as frequency, amplitude, andpulse width. Depending on the diagnostic or therapeutic treatmentrendered, the probes may comprise one electrode containing both acathode and an anode or may contain a plurality of electrodes with atleast one serving as a cathode and at least one serving as an anode.

Electrical therapy ablation may employ electroporation, orelectropermeabilization, techniques where an externally appliedelectrical field significantly increases the electrical conductivity andpermeability of a cell plasma membrane. Electroporation is thegeneration of a destabilizing electric potential across biologicalmembranes. In electroporation, pores are formed when the voltage acrossthe cell plasma membrane exceeds its dielectric strength.Electroporation destabilizing electric potentials are generally in therange of several hundred volts across a distance of several millimeters.Below certain magnitude thresholds, the electric potentials may beapplied across a biological membrane as a way of introducing somesubstance into a cell, such as loading it with a molecular probe, a drugthat can change the function of the cell, a piece of coding DNA, orincrease the uptake of drugs in cells. If the strength of the appliedelectrical field and/or duration of exposure to it are properly chosen,the pores formed by the electrical pulse reseal after a short period oftime, during which extra-cellular compounds have a chance to enter intothe cell. Thus, below a certain threshold, the process is reversible andthe potential does not permanently damage the cell membrane. Thisprocess may be referred to as reversible electroporation (RE).

On the other hand, the excessive exposure of live cells to largeelectrical fields (or potentials) can cause apoptosis and/ornecrosis—the processes that result in cell death. Accordingly, this maybe referred to irreversible electroporation (IRE) because the cells diewhen exposed to excessive electrical potentials across the cellmembranes. The various embodiments described herein are directed toelectrical therapy ablation devices such as electroporation ablationdevices. In one embodiment, the electroporation ablation device may bean IRE device to destroy cells by applying an electric potential to thecell membrane. The IRE potentials may be applied to cell membranes ofdiseased tissue in order to kill the diseased cells. The IRE may beapplied in the form of direct current (DC) electrical waveforms having acharacteristic frequency, amplitude, and pulse width.

Electroporation may be performed with devices called electroporators,appliances which create the electric current and send it through thecell. The electroporators may comprise two or more metallic (e.g., Ag,AgCl) electrodes connected to an energy source to generate an electricfield having a suitable characteristic waveform output in terms offrequency, amplitude, and pulse width.

Endoscopy means looking inside and refers to looking inside the humanbody for medical reasons. Endoscopy may be performed using an instrumentcalled an endoscope. Endoscopy is a minimally invasive diagnosticmedical procedure used to evaluate the interior surfaces of an organ byinserting a small tube into the body, often, but not necessarily,through a natural body opening. Through the endoscope, the operator isable to see abnormal or diseased tissue such as lesions and othersurface conditions. The endoscope may have a rigid or a flexible tube ormember and in addition to providing an image for visual inspection andphotography, the endoscope enables taking biopsies, retrieving foreignobjects, and introducing medical instruments to a tissue treatmentregion. Endoscopy is the vehicle for minimally invasive surgery.

The embodiments of the electrical therapy ablation devices may beemployed for treating diseased tissue, tissue masses, tissue tumors, andlesions (diseased tissue). More particularly, the electrical therapyablation devices may be employed in minimally invasive therapeutictreatment of diseased tissue. The electrical therapy ablation devicesmay be employed to deliver energy to the diseased tissue to ablate ordestroy tumors, masses, legions, and other abnormal tissue growths. Inone embodiment, the electrical therapy ablation devices and techniquesdescribed herein may be employed in the treatment of cancer by quicklycreating necrosis of live tissue and destroying cancerous tissuein-vivo. These minimally invasive therapeutic treatment of diseasedtissue where medical instruments are introduced to a tissue treatmentregion within the body of a patient through a natural opening are knownas Natural Orifice Translumenal Endoscopic Surgery (NOTES)™.

A biopsy is a medical procedure involving the removal of cells ortissues for examination. The tissue is often examined under a microscopeand can also be analyzed chemically (for example, using polymerase chainreaction [PCR] techniques). When only a sample of tissue is removed, theprocedure is called an incisional biopsy or core biopsy. When an entirelump or suspicious area is removed, the procedure is called anexcisional biopsy. When a sample of tissue or fluid is removed with aneedle, the procedure is called a needle aspiration biopsy. A procedurecalled “optical biopsy” may be employed where optical coherencetomography may be adapted to allow high-speed visualization of tissue ina living animal with a catheter-endoscope 1 millimeter in diameter.Optical biopsy may be used to obtain cross-sectional images of internaltissues.

Biopsy specimens may be taken from part of a lesion when the cause of adisease is uncertain or its extent or exact character is in doubt.Vasculitis, for instance, is usually diagnosed on biopsy. Additionally,pathologic examination of a biopsy can determine whether a lesion isbenign or malignant, and can help differentiate between different typesof cancer.

FIG. 1 illustrates one embodiment of an endoscopic ablation system 10.The endoscopic ablation system 10 may be employed to electrically treatdiseased tissue such as tumors and lesions. The endoscopic ablationsystem 10 may be configured to be positioned within a natural opening ofa patient such as the colon or the esophagus and can be passed throughthe opening to a tissue treatment region. The illustrated endoscopicablation system 10 may be used to treat diseased tissue via the colon orthe esophagus of the patient, for example. The tissue treatment regionmay be located in the esophagus, colon, liver, breast, brain, and lung,among others. The endoscopic ablation system 10 can be configured totreat a number of lesions and ostepathologies including but not limitedto metastatic lesions, tumors, fractures, infected site, inflamed sites,and the like. Once positioned at the target tissue treatment region, theendoscopic ablation system 10 can be configured to treat and ablatediseased tissue in that region. In one embodiment, the endoscopicablation system 10 may be employed as a diagnostic instrument to collecta tissue sample using a biopsy device introduced into the tissuetreatment region via an endoscope (e.g., the endoscopic ablation system10). In one embodiment, the endoscopic ablation system 10 may be adaptedto treat diseased tissue, such as cancers, of the gastrointestinal (GI)tract or esophagus that may be accessed orally. In another embodiment,the endoscopic ablation system 10 may be adapted to treat diseasedtissue, such as cancers, of the liver or other organs that may beaccessible trans-anally through the colon and/or the abdomen.

One embodiment of the endoscopic ablation system 10 may be mounted on aflexible endoscope 12 (also referred to as endoscope 12), such as theGIF-100 model available from Olympus Corporation. The flexible endoscope12 includes an endoscope handle 34 and a flexible shaft 32. Theendoscopic ablation system 10 generally comprises one or moretherapeutic/diagnostic probe 20, a plurality of conductors 18, ahandpiece 16 having a switch 62, and an electrical waveform generator14. In one embodiment, the electrical waveform generator 14 may be ahigh voltage direct current (DC) irreversible electroporation (IRE)generator. The therapeutic/diagnostic probe 20 is located at a distalend of the flexible shaft 32 and the conductors 18 attach to theflexible shaft 32 using a plurality of clips 30. Thetherapeutic/diagnostic probe 20 comprises an elongate member attached toan electrical energy delivery device comprising one or more electricaltherapy electrodes 28. In one embodiment, the therapeutic/diagnosticprobe 20 extends through a bore in the flexible shaft 32 such as aworking channel 36 (FIG. 2). In one embodiment, thetherapeutic/diagnostic probe 20 may comprise elongate diagnostic probes26 attached or joined to the electrodes 28 that extend through theworking channel 36. In another embodiment, the flexible shaft 32 maycomprise two working channels 36 and a first diagnostic probe 26 joinedto a first electrode 28 that extends through the distal end of a firstworking channels 36 and a second diagnostic probe 26 joined to a secondelectrode 28 that extends through the distal end of a second workingchannel 36. In one embodiment, the diagnostic probe comprises one ormore diagnostic probes 26 attached or joined in any suitable manner tothe electrodes 28. For example, the diagnostic probes 26 may be joinedor attached to the electrodes 28 by welding, soldering, brazing or otherwell known techniques. Many different energy sources may be used forwelding, soldering, or brazing such as, for example, a gas flame, anelectric arc, a laser, an electron beam, friction, and ultrasound. Thus,in one embodiment, the therapeutic/diagnostic probe 20 may be employedin a diagnostic mode to take a biopsy sample of the diseased tissueusing the diagnostic probes 26 and, in one embodiment thetherapeutic/diagnostic probe 20 may be employed in a therapeutic mode bytreating diseased tissue with electrical current delivered by theelectrodes 28. In other embodiments, the therapeutic/diagnostic probe 20may be employed in a combination of therapeutic and diagnostic modes.The therapeutic/diagnostic probe 20 may be passed though the one or moreworking channels 36 located within the flexible shaft 32. Thetherapeutic/diagnostic probe 20 is delivered to the tissue treatmentregion endoscopically and is located on top of the diseased tissue to beelectrically treated. Once the therapeutic/diagnostic probe 20 issuitably located by the operator, manual operation of the switch 62 onthe handpiece 16 electrically connects or disconnects the electrodes 28to the electrical waveform generator 14. Alternatively, the switch 62may be mounted on, for example, a foot switch (not shown).

In one embodiment, the electrical waveform generator 14 may be aconventional, bipolar/monopolar electrosurgical generator (ICC200 ErbeInc.) or an IRE generator such as one of many models commerciallyavailable, including Model Number ECM800, available from BTX Boston,Mass. The IRE generator generates electrical waveforms havingpredetermined frequency, amplitude, and pulse width. The application ofthese electrical waveforms to the cell membrane causes the cell to die.The IRE electrical waveforms are applied to the cell membranes ofdiseased tissue in order to kill the diseased cells and ablate thediseased tissue. IRE electrical waveforms suitable to destroy the cellsof diseased tissues energy are generally in the form of direct current(DC) electrical pulses delivered at a frequency in the range of 1-20 Hz,amplitude in the range of 100-1000 VDC, and pulse width in the range of0.01-100 ms. For example, an electrical waveform having amplitude of 500VDC and pulse duration of 20 ms may be delivered at a pulse repetitionrate or frequency of 10 HZ can destroy a reasonably large volume ofdiseased tissue. Unlike RF ablation systems which require high power andenergy input into the tissue to heat and destroy the tissue, IRErequires very little energy input into the tissue, rather thedestruction of the tissue is caused by high electric fields. It has beendetermined that in order to destroy living tissue, the waveforms have togenerate an electric field of at least 30,000 V/m in the tissuetreatment region. In one embodiment, the IRE generator 14 may generatevoltages from about 100-1000 VDC. The IRE generator 14 may generatevoltage pulses from 0.01-100 ms. These pulses may be generated at asuitable pulse repetition rate. The electrical current depends on thevoltage amplitude, pulse width, pulse repetition rate, and the volume oftissue being treated. In one embodiment, the IRE generator 14 generates20 ms pulses of 500 VDC amplitude between the electrodes 28. Theembodiments, however, are not limited in this context.

When using the IRE generator 14 in monopolar mode with two or moreelectrical therapy electrodes 28, a grounding pad is not needed on thepatient. Because a generator will typically be constructed to operateupon sensing connection of ground pad to the patient when in monopolarmode, it can be useful to provide an impedance circuit to simulate theconnection of a ground pad to the patient. Accordingly, when theelectrical ablation system 10 is used in monopolar mode without agrounding pad, an impedance circuit can be assembled by one skilled inthe art, and electrically connected in series with one of the electricaltherapy electrodes 28 that would otherwise be used with a grounding padattached to a patient during monopolar electrosurgery. Use of animpedance circuit allows use of the IRE generator 14 in monopolar modewithout use of a grounding pad attached to the patient.

FIG. 2 is an enlarged view of one embodiment of thetherapeutic/diagnostic probe 20 of one embodiment of the endoscopicablation system 10 shown in FIG. 1. The therapeutic/diagnostic probe 20extends through the distal end of the flexible shaft 32. In oneembodiment, the therapeutic/diagnostic probe 20 protrudes from thedistal end of an internal lumen extending between the proximal anddistal ends of the flexible endoscope 12. In one embodiment, thetherapeutic/diagnostic probe 20 may comprise a biopsy device adapted andconfigured to remove sample tissue using an incisional, core, needleaspiration, or optical biopsy techniques. In one embodiment, the biopsydevice comprises one or more diagnostic probes 26. As previouslydiscussed, the electrical therapy electrodes 28 may be joined orattached to the diagnostic probes 26 in any suitable manner.

As previously discussed, the electrical therapy electrodes 28 areconnected to the diagnostic probes 26 in any known suitable manner andare located in a spaced-apart relationship so as to define a distance Dbetween the electrodes. The distance D is adjustable and can beincreased or decreased by rotating one or both of the diagnostic probes26. The therapeutic/diagnostic probe 20 are rotatable about a centralaxis 39. Thus, the diagnostic probes 26 and the electrodes 28 arerotatable about the central axis 39. The electrodes 28 may be rotated toincrease or decrease the relative distance D between the electrode 28either to focus the energy in a smaller tissue region or to enlarge thetissue treatment region. In this manner, the operator can surround thediseased tissue such as a cancerous lesion, a polyp, or a tumor. Theelectrodes 28 are energized with the electrical waveform generator 14 totreat the diseased tissue. The diagnostic probes 26 have a sharp tooth33 at the distal end and are moveable from the distal end to theproximal end of the flexible shaft 32 capable of slicing a thin sectionof the tissue to obtain a biopsy sample (shown in more detail below).The diagnostic probes 26 may comprise a bore 35 (FIGS. 3A, B) at thedistal end extending from a proximal end to the distal end of thediagnostic probes 26. Suction may be applied at the proximal end of theprobes to remove a tissue sample before and/or after treatment throughthe bore 35 (FIGS. 3A, B) formed through the diagnostic probes 26.

The electrical therapy electrodes 28 may be positioned in anyorientation relative to the diagnostic probes 26. The electrodes 28 andthe diagnostic probes 26 may have any suitable shape. In the illustratedembodiment, the electrodes 28 may have a generally cuboidal shape andthe diagnostic probes 26 may have an elongate cylindrical shape with asharp tooth 33 and a bore 35 formed therein at the distal end. Theelectrical conductors 18 are electrically insulated from each other andsurrounding structure except for the electrical connections theelectrodes 28. The distal end of the flexible shaft 32 of the flexibleendoscope 12 may comprise a light source 40, a viewing port 38, and oneor more working channels 36. The viewing port 38 transmits an imagewithin its field of view to an optical device such as a charge coupleddevice (CCD) camera within the flexible endoscope 12 so that an operatormay view the image on a display monitor (not shown). In the embodimentshown in FIG. 2, the distal end of flexible shaft 32 is proximal to theelectrodes 28 and is within the viewing field of the flexible endoscope12 to enable the operator to see the diseased tissue to be treatedbetween the electrodes 28.

FIG. 3A is a side view of the distal end of one embodiment of thetherapeutic/diagnostic probe 20 comprising a biopsy probe 26 and anelectrical therapy electrode 28 assembly. FIG. 3B is a sectional view ofone embodiment of a therapeutic/diagnostic probe 20 taken along sectionline 3B-3B showing the geometric relationship between the electrodes 28and the diagnostic probes 26. In the embodiment illustrated in FIGS. 3A,B, the cuboidal electrodes 28, each have a width “w,” a length “l,” anda thickness or height “h.” The electrodes 28 have parallel, adjacentedges 8 separated by a distance “D.” This geometry of the electrodes 28,the distance D between them, and the electrical waveform may be used tocalculate an ablation index, which has particular significance to thelocation, size, shape, and depth of ablation achievable, as will bedescribed later. The diagnostic probes 26 may be juxtaposed with theelectrodes 28. In this embodiment, the two cylindrically elongatediagnostic probes 26 have a bore 35 for removing ablated tissue ortaking biopsy samples of the tissue by way of suction. The length of thediagnostic probes 26 may extend through the entire length of theflexible endoscope 12. The conductors 18 are attached to the electrodes28 in any suitable manner including welding, soldering, or brazing andmay employ many different energy sources such as, for example, a gasflame, heat source, an electric arc, a laser, an electron beam,friction, and ultrasound. The electrodes 28 are attached to thediagnostic probes 26 and may be rotated about the central axis 39 in thedirections indicated by arrows 31 a and 31 b.

FIG. 4 is a sectional view of the lower end of an esophagus 42 and theupper portion of a stomach 54 of a human being. The esophagus 42 has amucosal layer 46, a muscular layer 44, and a region of diseased tissue48. The boundary between the mucosal layer 46 of the esophagus 42 and agastric mucosa 50 of the stomach 54 is a gastro-esophageal junction 52,which is approximately the location for the lower esophageal sphincter(LES). The LES allows food to enter the stomach 54 while preventing thecontents of the stomach 54 from refluxing into the lower esophagus 42and damaging the mucosal layer 46. The diseased tissue 48 can developwhen chronic reflux is not treated. In one form, the diseased tissue 48may be, for example, intestinal metaplasia, which is an early stage ofBarrett's esophagus. As can be seen in FIG. 4, the esophagus 42 isrelatively flaccid and contains numerous folds and irregularities on theinterior lining.

FIG. 5 illustrates the use of one embodiment of the endoscopic ablationsystem 10 to treat the diseased tissue 48 in the lower esophagus 42. Theoperator positions the therapeutic/diagnostic probe 20 using endoscopicvisualization so that the diseased tissue 48 to be treated is within thefield of view of the flexible endoscope 12. Once the operator positionsthe therapeutic/diagnostic probe 20 such that the electrical therapyelectrodes 28 are located above the diseased tissue 48, the operator mayenergize the electrodes 28 with the electrical waveform generator 14 todestroy the diseased tissue 48 in the tissue treatment region. Forexample, the electrodes 28 may be energized with an electrical waveformhaving amplitude of approximately 500 VDC and a pulse width ofapproximately 20 ms at a frequency of approximately 10 Hz. In thismanner, the diseased tissue 48 in the tissue treatment region may bedestroyed. This procedure may take very little time and may be repeatedto destroy relatively larger portions of the diseased tissue 48. Suctionmay be applied to remove the treated tissue sample through the bore 35formed in the diagnostic probes 26.

FIG. 6 illustrates the use of the endoscopic ablation system 10 to treatthe diseased tissue 48 in the lower esophagus 42. As shown in theillustrated embodiment, the electrical therapy electrodes 28 can berotated about the central axis 39 in the direction indicated by arrows31 a and 31 b. The treated tissue can be sucked into the bore 35 of thebiopsy probe 26 by applying suction to thereto.

FIG. 7 illustrates one embodiment of a necrotic zone 70 defined by thegeometry and placement of the electrical therapy electrodes 28. Theenergy delivered by the waveform to the electrodes 28 in terms offrequency, amplitude, and pulse width should be suitable to destroy thetissue in the necrotic zone 70. Based on the location and geometry ofthe electrodes 28, and the energy delivered thereto, the necrotic zone70 in the illustrated embodiment may be approximated generally as avolume of width “wnz,” a thickness “tnz,” and a length “Inz.” Energizingthe electrodes 28 destroys the diseased tissue 48 within the necroticzone 70. In one embodiment, electrodes 28 with a width “w=0.5 mm,” alength “l=10 mm,” and a thickness “h=0.5 mm” (as shown in FIGS. 3A, B)and a waveform of approximately 500 VDC, a pulse width of 20 ms, and afrequency of 10 Hz, would define a necrotic zone 70 with dimensions ofapproximately wnz=6 mm wide, lnz=10 mm long, and hnz=2 mm deep. If abiopsy indicates that the treatment region includes dysplastic ormalignant cells, or if the treatment region is larger than the necroticzone 70, the process may be repeated until all the diseased tissue 48 isdestroyed in the treatment region and clean margins are recorded. In oneembodiment, optical biopsy may be used as an alternative to the vacuumdiagnostic probes 26 shown in the illustrated embodiments.

FIG. 8 is a sectional view taken along the longitudinal axis of oneembodiment of an endoscopic ablation system 10 shown in FIG. 1. Thedistal portion of the flexible shaft 32 is located inside a rotationtube 22 of the endoscopic ablation system 10. The pair of electricalconductors 18 pass through a strain relief 66 of a rotation knob 58. Inthe illustrated embodiment an external tube 64 may be located over theflexible shaft 32 such that the conductors 18 pass between the externaltube 64 and the rotation tube 22. Each of the conductors 18 connectelectrically to the electrical therapy electrodes 28 in thetherapeutic/diagnostic probe 20. The rotation tube 22 rotatably joinsthe rotation knob 58. The operator can rotatably orient the electrodes28, even after insertion into the esophagus, by remotely rotating thediagnostic probes 26 about the central axis 39 of each of thetherapeutic/diagnostic probe 20. The therapeutic/diagnostic probe 20 iswithin the field of view of the flexible endoscope 12, thus enabling theoperator to see on a display monitor the tissue that is located betweenthe electrodes 28. Optionally, in one embodiment, a valve element (notshown) may extend from the distal end of therapeutic/diagnostic probe 20to prevent tissue or fluids from entering the therapeutic/diagnosticprobe 20.

FIG. 9 is an end view taken along line 9-9 of one embodiment of thetherapeutic/diagnostic probe 20 of the endoscopic ablation system 10shown in FIG. 8. The electrical conductors 18 connect to the electricaltherapy electrodes 28. The rotation tube 22 retains the flexible shaft32. The inside diameter of the rotation tube 22 is larger than the outerdiameter of the flexible endoscope 12 to allow rotation of the rotationtube 22 while holding the flexible endoscope 12 stationary, or viceversa. Each of the therapeutic/diagnostic probe 20 comprising thediagnostic probes 26 attached to the electrodes 28 extend outwardly fromthe distal end of the flexible shaft 32 through each of the workingchannels 36. In this embodiment, the operator may endoscopically viewthe tissue between the electrodes 28. The flexible endoscope 12 includesthe light source 40, the viewing port 38, and the one or more workingchannels 36.

FIG. 10 is a sectional view taken along line 10-10 of the rotation tube22 of the endoscopic ablation system 10 shown in FIG. 8. The externaltube 64 and the rotation tube 22 assemble and retain the electricalconductors 18 as already described. The light source 40, the viewingport 38, and the one or more working channels 36 of the flexibleendoscope 12 are shown.

FIG. 11 shows one embodiment of the distal portion of the endoscopicablation system 10 shown in FIG. 1 partially inserted into the esophagus42 of a patient. A tapered end cover 84 dilates the esophagus 42 as theoperator gently inserts the therapeutic/diagnostic probe 20 forpositioning near the diseased tissue 48 to be ablated. A flexiblecoupling 88 flexes as shown, reducing the required insertion force andminimizing trauma (and post-procedural pain).

The operator may treat the diseased tissue 48 using the embodiment ofthe endoscopic ablation system 10 comprising the therapeutic/diagnosticprobe 20 shown in FIGS. 1-3 and 5-11 as follows. The operator insertsthe flexible shaft 32 of the endoscope 12 into the lower esophagus 42trans-orally. A rigid support member at the distal end of the endoscope12 holds the lower esophagus 42 open as the operator uses endoscopicvisualization through the therapeutic/diagnostic probe 20 to positionthe electrical therapy electrodes 28 next to the diseased tissue 48 tobe treated. The rigid support member opens and supports a portion of theflaccid, lower esophagus 42 and helps to bring the diseased tissue 48 tobe treated into intimate contact with the electrodes 28 and within thefield of view of the flexible endoscope 12. While watching through theviewing port 38, the operator actuates the switch 62, electricallyconnecting the electrodes 28 to the electrical waveform generator 14through the electrical conductors 18. Electric current then passesthrough the portion of the diseased tissue 48 positioned between theelectrodes 28 and within the field of view. When the operator observesthat the tissue in the field of view has been ablated sufficiently, theoperator deactuates the switch 62 to stop the ablation. The operator mayreposition the electrodes 28 for subsequent tissue treatment, or maywithdraw the therapeutic/diagnostic probe 20 (together with the flexibleendoscope 12).

FIG. 12 is a diagram of one embodiment of a control loop 80 for oneembodiment of an IRE therapy procedure to treat diseased tissue asdescribed herein. As previously discussed, the IRE therapy may beeffective in quickly creating necrosis of live tissue and destroyingdiseased (e.g., cancerous) tissue in-vivo. Real time informationfeedback about the size in volume of a necrotic zone may be helpfulduring an IRE therapy procedure for focal treatment of diseased tissue48.

Prior to an IRE therapy procedure, a patient 82 will have an image ofthe diseased tissue 48 taken for clinical purposes in an effort toreveal, diagnose, or examine the diseased tissue 48 and to identify itslocation more precisely. The image information 84 will generally includegeometric information about the volume of the diseased tissue 48. Theimage information 84 is provided to an image processing module 86 tocalculate the volume of the diseased tissue 48 and to display a virtualmodel of the diseased tissue 48 on a monitor. The image processingmodule 86 may comprise, for example, image processing softwareapplications such as Comsol Multiphysics available by Comsol, Inc. toreceive the image information 84, extract the geometric information, anddetermine (e.g., calculate) the voltage required to treat the propervolume and outline of the necrotic zone required to treat the diseasedtissue 48. The image processing module 86 creates a virtual model of atreatment zone necessary to treat the diseased tissue 48. The imageprocessing module 86 then determines waveform parameters 88 of asuitable electrical waveform necessary to destroy the diseased tissue48. The waveform parameters 88 include the frequency, amplitude, andpulse width of the electrical waveform to be generated by the waveformgenerator 14. The waveform generator 14 would then generate the suitableelectrical waveform to destroy the diseased tissue 48 based on thecalculated waveform parameters 88.

The image processing module 86 also comprises image processing softwareapplications such as Matlab available by MathWorks, Inc. to receive theimage information 84 and the virtual model and display an image of thediseased tissue 48 overlaid with an image of the virtual model. Theoverlaid images enable the operator to determine whether the calculatedelectrical waveform parameters 88 are suitable for destroying thediseased tissue 48, whether too strong or too weak. Thus, the IREwaveform parameters 88 may be adjusted such that the virtual model imagesubstantially over-lays the entire diseased tissue image. The calculatedparameters 88 are provided to the waveform generator 14 and the diseasedtissue may be treated with an electrical waveform 89 based on thecalculated parameters 88 as discussed herein. After the diseased tissue48 is treated with the electrical waveform 89, a new image of thediseased tissue 48 can be generated to determine the extent oreffectiveness of the treatment. The cycle may be repeated as necessaryto ablate the diseased tissue 48 as much as possible.

FIG. 13 illustrates one embodiment of an electrical scalpel 90 fordissecting tissue 92. In one embodiment, the electrical scalpel 90 maybe driven by an IRE waveform previously described. The scalpel 90comprises a blade 98 that is formed of metal such as hardened andtempered steel (and/or stainless in many applications). The blade 98 isconnected to the electrical waveform generator 14 by multiple electricalconductors 96. The electrical waveform generator 14 may generate an IREwaveform (e.g., 10 Hz frequency, 500 VDC amplitude, and 20 ms pulse). Asthe blade 98 dissects the tissue 92 along an incision 100, theelectrical waveform generator 14 may be activated or pulsed to create atissue destruction zone 94 surrounding the blade 98. Accordingly, as theblade 98 dissects the diseased tissue 92 it generates the tissuedestruction zone 94 beyond the incision 100. This may help to ensure thedestruction of any diseased tissue cells left behind. The pulserepetition rate or frequency of the electrical waveform generated by thegenerator 14 may be selected to provide a continuous zone of tissuedestruction 94 as the blade 98 moves through the diseased tissue 92. Inone embodiment, a feedback signal (e.g., audio, visual, or cut-off ofelectrical power to the blade 98) may be provided to the operator toindicate that the scalpel 90 is moving too quickly.

FIG. 14 is a graphical representation 110 (graph) of electric fieldstrength (along the y-axis) as a function of distance from an electricaltherapy electrode 28 under various conductivity environments near thediseased tissue 48. FIG. 15 is a close up of the graph 110 shown in FIG.14A. In electrical therapy of diseased tissue 48, the volume of tissuethat can be destroyed by an electrical waveform (e.g., the necroticzone) may be defined by a minimum electric field strength applied to thetissue treatment region. The electric field strength in the tissuetreatment region varies throughout the tissue as a function of theapplied electrical waveform parameters frequency, amplitude, and pulsewidth as well as the conductivity of the tissue in the treatment region.When a single electrical therapy electrode 28 is located in a firstposition in the tissue treatment region of interest and a return pad isplaced at a distance relatively far from the first position, an electricfield is generated around the electrode 28 when it is energized with aparticular electrical waveform. The magnitude of the electric field,however, diminishes rapidly in the radial direction away from theelectrode 28. When two electrodes 28 are placed relatively closetogether, a larger pattern of tissue can be destroyed. Injecting a fluidhaving a higher conductivity than the tissue into the tissue treatmentregion extends the electric field of sufficient strength to destroy thetissue radially outwardly from the electrode 28. Thus, the addition of afluid having higher conductivity than the tissue to be treated creates alarger tissue destruction zone by extending the electric field radiallyoutwardly from the electrodes 28.

The graph 110 illustrates the electric field strength, along the y-axis,as a function of the radial distance from the electrical therapyelectrode 28. The y-axis is labeled in units of volts/meter (V/m×e⁵) andthe x-axis is labeled in units of mm. The graph 110 illustrates a familyof three functions with conductivity as a parameter. A first function112 illustrates the electric field strength as a function of the radialdistance from one of the electrodes 28 with no conductivity plugintroduced into the tissue treatment region. A second function 114illustrates the electric field strength as a function of the radialdistance from one of the electrodes 28 with a conductivity plug of 0.2S/m introduced in the tissue treatment region. A third function 116illustrates the electric field strength as a function of the radialdistance from one of the electrodes 28 with a conductivity plug of 0.5S/m introduced in the tissue treatment region. As shown in the graph110, the peak electric field strength of each of the functions 112, 114,116 decreases with increased conductivity in the tissue treatment regionin proximity to the electrode 28. However, the threshold 118 of each ofthe functions 112, 114, 116 where the electric field strength dropsbelow the minimum threshold 118 of electric field strength required todestroy tissue becomes wider as the conductivity increases. In otherwords, increasing the conductivity of the tissue in the tissue treatmentregion extends the range of an effective electric field to destroytissue or creates a larger necrotic zone. In one embodiment, the minimumelectric field strength threshold 118 is approximately 30,000 V/m.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Preferably, the various embodiments of the invention described hereinwill be processed before surgery. First, a new or used instrument isobtained and if necessary cleaned. The instrument can then besterilized. In one sterilization technique, the instrument is placed ina closed and sealed container, such as a plastic or TYVEK bag. Thecontainer and instrument are then placed in a field of radiation thatcan penetrate the container, such as gamma radiation, x-rays, orhigh-energy electrons. The radiation kills bacteria on the instrumentand in the container. The sterilized instrument can then be stored inthe sterile container. The sealed container keeps the instrument sterileuntil it is opened in the medical facility.

It is preferred that the device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam.

Although the various embodiments of the invention have been describedherein in connection with certain disclosed embodiments, manymodifications and variations to those embodiments may be implemented.For example, different types of end effectors may be employed. Also,where materials are disclosed for certain components, other materialsmay be used. The foregoing description and following claims are intendedto cover all such modification and variations.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. An apparatus, comprising: an elongate shaft; afirst channel and a second channel defined in the elongate shaft; afirst probe positioned at least partially within the first channel,wherein the first probe comprises a first distal-most portion anddefines a first longitudinal axis extending to the first distal-mostportion, wherein the first distal-most portion is laterally aligned withthe first longitudinal axis, and wherein the first probe is rotatablewithin the first channel; a first electrode coupled to the firstdistal-most portion of the first probe and laterally offset from thefirst longitudinal axis, wherein the first electrode is structured torotate about the first longitudinal axis via the first probe, andwherein the first electrode is configured to couple to a bipolarelectrical waveform generator; a first conductor external to the firstchannel, wherein the first conductor is electrically coupled to thefirst electrode, and wherein the first conductor extends from a positivepole of the bipolar electrical waveform generator to the firstelectrode; a second probe positioned at least partially within thesecond channel, wherein the second probe comprises a second distal-mostportion and defines a second longitudinal axis extending to the seconddistal-most portion, and wherein the second distal-most portion islaterally aligned with the second longitudinal axis; a second electrodecoupled to the second distal-most portion of the second probe andlaterally offset from the second longitudinal axis, wherein the secondelectrode is configured to couple to the bipolar electrical waveformgenerator; a second conductor external to the second channel, whereinthe second conductor is electrically coupled to the second electrode,and wherein the second conductor extends from a negative pole of thebipolar electrical waveform generator to the second electrode; and anadjustable ablation region defined between the first and secondelectrodes, wherein the ablation region is adjustable by rotating thefirst probe.
 2. The apparatus of claim 1, further comprising a strainreliever, wherein the first and second conductors extend through thestrain reliever.
 3. The apparatus of claim 1, wherein the first andsecond electrodes are configured to receive an irreversibleelectroporation electrical waveform, and wherein the irreversibleelectroporation electrical waveform generates an electrical field of atleast 30,000 V/cm in the adjustable ablation region.
 4. The apparatus ofclaim 1, wherein the second probe is rotatable within the second channeland wherein the ablation region is adjustable by rotating the first andsecond electrodes.
 5. The apparatus of claim 1, further comprising anendoscope, wherein the endoscope comprises the first channel and thesecond channel.
 6. The apparatus of claim 5, further comprising: anilluminator positioned to illuminate tissue; and an image sensorpositioned to image tissue therethrough.
 7. The apparatus of claim 1,wherein the first and second electrodes are configured to access atissue treatment region in a lung.
 8. An apparatus, comprising: anelongate shaft; a first channel and a second channel defined in theelongate shaft; a first probe positioned at least partially within thefirst channel, wherein the first probe comprises a first distal-mostportion and defines a first longitudinal axis, wherein the firstdistal-most portion is aligned with the first channel, and wherein thefirst probe is rotatable within the first channel; a first electrodeextending from the first distal-most portion of the first probe andlaterally offset from the first longitudinal axis, wherein the firstelectrode is structured to rotate about the first longitudinal axis viathe first probe, and wherein the first electrode is configured to coupleto a bipolar electrical waveform generator; a first conductor inelectrical communication with the first electrode, wherein the firstconductor is positioned outside the elongate shaft, and wherein thefirst conductor extends from one of a positive pole or a negative poleof the bipolar electrical waveform generator to the first electrode; asecond probe positioned at least partially within the second channel,wherein the second probe comprises a second distal-most portion anddefines a second longitudinal axis, and wherein the second distal-mostportion is aligned with the second channel; a second electrode extendingfrom the second distal-most portion of the second probe and laterallyoffset from the second longitudinal axis, wherein the second electrodeis configured to couple to the bipolar electrical waveform generator; asecond conductor in electrical communication with the second electrode,wherein the second conductor is positioned outside the elongate shaft,and wherein the second conductor extends from the other of the positivepole or the negative pole of the bipolar electrical waveform generatorto the second electrode; wherein the first and second electrodes areconfigured to receive an irreversible electroporation electricalwaveform through the respective first and second conductors; and anadjustable ablation region defined between the first and secondelectrodes, wherein the ablation region is adjustable by rotating thefirst probe.
 9. The apparatus of claim 8, further comprising a strainreliever, wherein the first and second conductors extend through thestrain reliever.
 10. The apparatus of claim 8, wherein the irreversibleelectroporation electrical waveform generates an electric field of atleast 30,000 V/m in the adjustable ablation region.
 11. The apparatus ofclaim 8, comprising: an illuminator positioned to illuminate tissue; andan image sensor positioned to image tissue therethrough.
 12. Theapparatus of claim 8, wherein the second probe is rotatable within thesecond channel and wherein the ablation region is adjustable by rotatingthe first and second electrodes.
 13. A method, comprising: positioningan elongate member comprising first and second channels within a bodycavity, wherein a first and a second probe are disposed within therespective first and second channels, wherein the first and secondprobes each define a central axis, wherein the first and second probeseach comprise a distal-most end aligned with the respective centralaxis, wherein a first and a second electrode are coupled to thedistal-most ends of the respective first and second probes, wherein thefirst and second electrodes are laterally offset from the central axesof the respective first and second probes, and wherein a first and asecond conductor disposed external to the respective first and secondchannels are electrically coupled to the respective first and secondelectrodes; and rotating at least one of the first and second probeswithin the respective first and second channels about the central axisof the respective at least one first and second probes to adjust anablation region positioned between the first and second electrodes; andapplying an irreversible electroporation (IRE) electrical waveformsufficient to ablate tissue positioned within the ablation region with abipolar electrical waveform generator electrically coupled to the firstand second electrodes through the respective first and second conductorsthat extend from a respective positive and negative pole of the bipolarelectrical waveform generator to the respective first and secondelectrodes.
 14. The method of claim 13, wherein the IRE electricalwaveform is suitable to destroy diseased tissue in the ablation region,and wherein the IRE electrical waveform parameters comprise amplitude,frequency, and pulse width.
 15. The method of claim 13, furthercomprising generating an electric field of at least 30,000 V/m in theablation region.
 16. The method of claim 13, further comprisinginjecting a fluid into the ablation region, wherein the fluid has ahigher conductivity than diseased tissue in the ablation region.
 17. Themethod of claim 13, further comprising: illuminating the ablation regionwith at least one illuminator positioned to illuminate tissue; andimaging the ablation region with an image sensor positioned to imagetissue therethrough.
 18. The method of claim 17, further comprisingmodifying the IRE electrical waveform based on the imaged tissue in theablation region.
 19. The method of claim 13, further comprisingpositioning the elongate member in a tissue treatment region located ina lung.